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2011 SDPhA Associate Membership Application
annual fee: $100.00
Name/company: ________________________________________________________________
Mailing Address: _______________________________________________________________
City/State/Zip: _________________________________________________________________
Employer: _______________________________________________________________________
Employer Address: _____________________________________________________________
Work Phone: ___________________________________________________________________
Fax: _____________________________ EMail: ________________________________________
Mail the journal to my address: work or home (Circle one)
Primary contact person:____________________________________________________
Make check payable and mail to SD Pharmacists Association – Po Box 518- Pierre, SD 57501
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